Overview of otitis externa

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Presentation transcript:

Overview of otitis externa Anita Sonsale Walsall Manor Hospital Jan 2015

Objectives Pathogenesis Predisposing factors Principles of treatment Current evidence

Classification Acute localised otitis externa- furuncle Acute diffuse otitis externa- commonly bacterial Chronic otitis externa Eczematous otitis externa Fungal otitis externa Necrotising/ malignant otitis externa

45 year old lady comes with right ear pain with itching and discharge 45 year old lady comes with right ear pain with itching and discharge. She has just returned from holiday in Cyprus.

Pathophysiology Superficial infection of EAC Obstruction- cerumen, narrow EAC, exostosis EAC, hearing aid Trauma PH alteration Role of PH of external auditory canal in acute otitis externa. Kumar S,Indian j head and neck surgery 2014, Jan 66(1):86-91

Predisposing factors Trauma Wet/ humid Skin conditions- eczema, psoriasis

Bacterial Pseudomonas aeruginosa- commonest Staphylococcus species Gram negative Anaerobes

Fungal Aspergillus Candida

Diffuse otitis externa Spreading Resistant May have evidence of chondritis

Principles of treatment Topical treatment in uncomplicated OE- Suction Analgesics Keeping ear dry Ear swabs - only in resistant/ chronic OE

Ear swab Only if condition does not improve with empirical topical treatment OE is recurrent After ear surgery Infection beyond EAC BMJ 2014 Llor, McNulty et al

A study of acute otitis externa at Wellington hospital 2007-2011, Jayakar, Sanders, Jones Australasian Med J 2014

History of previous ear problem-?perforation State of ear canal Choice of ear drops History of previous ear problem-?perforation State of ear canal If the swab results available Cost Sofradex ear drops- £6.25 + VAT Gentisone HC ear drops- £4.76+VAT Cipro- £4.70+VAT Otomise ear spray- £3.50+ VAT Locartan vioform ear drops- £1.76+ VAT

Delivery of ear drops Narrow EAC Use of Pope wick

Pitfalls Necrotising OE Malignancy - SCC Exostosis

Post head injury- fracture temporal bone, facial palsy AOM Mastoiditis- Post head injury- fracture temporal bone, facial palsy